Ski Equipment, Ski Hire, Ski Pack & Piste Closure Claim Form

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1 Personal details Title Mr Mrs Miss Ms Other Family name Date of birth Address First name N.I number Post code Daytime tel no. address Evening tel no Occupation Policy details Company name Policy number Date of booking Date of travel Travel agent If applicable Date of issue Destination Date of return Tour operator 1

2 Information we need from you for possible recovery opportunities Your Travel Policy has conditions attached whereby you must provide us with any information that assist any recovery actions. This is a standard practice in the insurance market and contributions made from other insurance cover serve to keep the costs of your premiums down. The information provided should not affect your renewal premiums or no claims discount. Please answer the following questions and provide details as required. For questions that require a YES / NO response, please tick the appropriate boxes. Failure to do so may delay your claim. 1. Do you have a bank account? Yes No A bank account you hold may offer Travel Insurance cover as part of the benefits. Under no circumstances will your bank account information be used other than to obtain a contribution from the Travel Insurance provider. This will not affect your bank account in any way. Name of bank (e.g. HSBC) Type of account Account holder name Account number 2. Was a credit card or debit card used to pay all or part of the trip cost? (Certain credit or debit cards provide an element of travel cover) Yes No Card issuer Type of card e.g. Visa Cardholder name Card number 3. Do you have a Household Contents insurance policy? (Some household contents policies provide an element of travel cover) Yes No Name of Insurer Policyholder name Policy number 4. Do you hold any Private Medical Insurance? Yes No Name of Insurer Policyholder name Policy number 5. Do you consider anyone to blame for the incident? Yes No If yes, please provide details. It is a condition of the policy and your responsibility to provide sufficient documentation to support your loss. Failure to provide the required documentation, including the details of any other insurances, will delay and may invalidate the claim. 2

3 Documents you need to send us - Send original documents and keep copies for your records 1. Original evidence to show your dates of outward and return travel, (booking invoice, travel tickets, itinerary etc.) 2. A police report, if your property was lost or stolen other than whilst in the custody of the carrier. 3. If your claim is for property lost, stolen damaged whilst in the custody of a carrier or their agent, written confirmation that no payment has been issued to you and all used travel tickets and baggage tags. 4. Damage Claims Only - please provide an estimate for repair. If the item is damaged beyond repair we require written confirmation from a relevant tradesman. Please retain all damaged items as we may require them to be forwarded to our offices. 5. Ski Equipment Claims - please provide pre-loss supporting documentation in the form of receipts or visa/bank statements showing the purchase of the items. PLEASE ANSWER ALL QUESTIONS BELOW - BLOCK CAPITALS PLEASE 6. Ski Hire Claims - receipts for hire expenses incurred, if your claim is a result of a delay by a carrier please provide a copy of their report and their written confirmation of the date and time that you received your equipment. 7. Ski Pack Claims - provide written confirmation from the treating physician in resort that you were unfit to ski and evidence of the pre-paid expenses for which you are claimimng e.g. receipts or ski pass. 8. Piste Closure Claims - written confiormation from the resort or your tour rep of the circumstances giving rise to the claim and if an alternative site was available receipts for transport expenses incurred in travelling there. If you are unable to supply any of the documentation requested, please provide a written explanation. Important - please number all receipts for expenses incurred or pre-loss supporting documentation and put the number in the column headed 'Ref' when completing the sections below. Ski Equipment Claims- Please provide details of lost, stolen, damaged or destroyed ski equipment Ref Description of item Owner Place of purchase Date acquired Purchase method Purchase price Office use only Ski Hire Claims - If ski equipment was hired due to your own equipment being lost, damaged or delayed please provide details Total Claimed From whom was the equipment hired From (date) Cost Office use only To (date) Currency Ski Pack Claims - If you lost your ski pack (ski school fees, ski/snowboard/boot hire, lift pass etc.) please provide details Please provide details of the circumstances giving rise to this claim Ski school fees Ski/snowboard/ boot hire Lift pass Cost Start date End date No. of days lost Piste Closure Claims - If you were unable to ski due to the piste at your pre-booked resort being closed due to a lack of snow or adverse weather conditions please provide details Date and time the piste was closed Date and time the piste was re-opened Were expenses incurred or an alternative site available? Yes No If YES advise cost of transport to an alternative site below Ref Description of expense Date incurred Cost Currency Office use only Total Claimed 3

4 Delayed Ski Equipment Claims Only Date and time of your arrival in resort Date and time equipment received How long was your equipment delayed Has compensation been received from the carrier? If so please provide documentary evidence of this. If no compensation received please state. Yes No Flight No. Flight Date PIR or Airline Ref No. Loss, Theft or Damage Claims Only Where and when did the loss, theft or damage occur? Date and time the loss, theft or damage was discovered Place of incident (country and resort or town). Was the incident reported to the Police (Date, time, ref) Carrier, e.g. Airline (Date, time, ref) Detail below the full circumstances surrounding the incident and the precautions taken to protect your property. Please continue on a seperate sheet if necessary Where were the items at the time of the loss, theft or damage? What action(s) did you take to attempt to recover your property? was the incident reported to any other authority, e.g. your holiday rep, rental car company or hotel etc? Please provide full details and a copy of their report if obtained, together with any other relevant information. ALL CLAIMS Have you or anyone else claiming made any previous claims for personal effects or money? Yes No If YES, please give full details below 4

5 Claimants declaration and signature 1. I declare that all details and particulars given in respect of the claim(s) made herein constitute a true and accurate statement. 2. To the best of my knowledge and belief I have not omitted any material information which would affect the insurer's assessment of this claim. 3. I confirm that where a claim or claims are made in respect of others, I have their full authority to act on their behalf. I also confirm that they have been advised that ETI will not accept any liability if any payments are not distributed proportionately to the persons concerned. 4. I am aware that an insurance claim made in the knowledge that any element thereof is fraudulent is a criminal offence and that this will invalidate the policy and will render me liable to prosecution. 5. I am, by this notice, aware that ETI will retain a computerised record of this claim and that they may release certain information to other insurers or other interested parties ETI maintain all data in accordance with the provisions of the Data Protection Act, Data protection act The insurance industry operates a number of anti fraud initiatives. The information given on this form may be stored electronically and shared with other organisation for this purpose. If you would prefer the information given here not to be used in this way, you should tick this box. I have read and understand the declaration above and included the necessary documents to substantiate my claim. Claimant(s) full name(s) Client's signature Date Full name of an authorised representative of the corporate policy holder (corporate and / or education group cover) Signature of authorised representative Date I / We authorise Client s signature to act on my behalf in this matter. Date ERV UK and ERV.co.uk is a brand name of ETI International Travel Protection the UK Branch of Europäische Reiseversicherung (ERV) A.G. Munich, an ERGO Group Company, incorporated and regulated under the laws of Germany, Companies House Registration FC and Branch Registration BR ERV is authorised by the Bundesanstalt für Finanzdienstleistungsaufsicht (BAFIN - and the Prudential Regulation Authority and subject to limited regulation by the Financial Conduct Authority and Prudential Regulation Authority. The Financial Ombudsman Service, South Quay Plaza 2, 183 Marsh Wall, London E14 9SR The Association of British Insurers, 51 Gresham Street, London EC2V 7HQ 5